In every issue of Herbs for Health, professionals from a variety of health-care fields answer your questions about using medicinal herbs. In this issue, Rosemary Gladstar and Jill Stansbury answer your questions on ­hysterectomies and natural hormones, how long to take herbal remedies, and elbow inflammation.

Rosemary Gladstar, author of Herbal Healing for Women (Simon & Schuster, 1993), and several other books on herbalism, runs Sage Mountain Retreat Center and Native Plant Preserve in East Barre, Vermont. Her experience includes more than twenty years in the herbal community as a healer, teacher, visionary, and organizer of herbal events.

Jill Stansbury has been a naturopathic physician for more than ten years, with a private practice in Battleground, Washington. She is the chair of the Botanical Medicine Department at the National College of Naturopathic Medicine in Portland, Oregon, and the author of many books including Herbs for Health and Healing (Publication International, 1997)..

The information offered in “Q & A” is not intended to be a substitute for advice from your health-care provider.

What about a hysterectomy?

I had a hysterectomy in 1992. Would I be considered “post menopause,” or does the fact that I will not go through natural menopause mean that articles about menopause don’t apply to me? Also, at what point, if ever, do you stop taking estrogen? My doctor says never.
P.
Reddick, Florida

Just because a woman has had a hysterectomy doesn’t mean that she will not have the opportunity to experience menopause, a natural and important cycle for women. Menopause is not related to a body part but our entire being; we are not the sum total of different body parts, but a complex system that is completely interdependent.

When the reproductive organs are removed, the remainder of the body/ mind/spirit responds and in some manner takes over for the missing parts. Though there are certainly women who need to take estrogen following a hysterectomy, there are countless others who have cut back or eliminated the need for synthetic hormones by using herbs and incorporating dietary changes to support their systems.

My suggestion to women who have had hysterectomies is to relate to their body as if all the parts were there—to envision the rich landscape of their being as whole and complete and to treat it as such. Follow the suggestions for menopause outlined in herb books or, better yet, see a holistic practitioner who can customize a program for you. Everyone will not necessarily respond to natural therapies in the same way, and not everyone responds to synthetic forms of estrogen. We must continuously educate ourselves and then listen and respond to the inherent wisdom of our bodies.
—Rosemary Gladstar

Herbs generally do not lose their effectiveness over time —Jill Stansbury

You don’t say your age and whether it’s time for natural menopause, or whether your hysterectomy included removal of the ovaries. Regardless, menopause still applies to you. Even if you’ve had a hysterectomy, the menopausal transition affects the skeletal, cardiovascular, mental/ emotional, and urinary systems.

Hormone replacement therapy (HRT) is thought to help protect you from all these ailments, though it’s not the entire solution for heart, bone, or emotional health. The issue of estrogen replacement therapy is controversial. There are many types of estrogen on the market—some synthetic, some natural, some are of estradiol only, and some are a combination of all the body’s estrogens. Questions about HRT range from who should use hormones, to how long they should be used, to what types should be taken. Each of these questions requires a lengthy discussion. Furthermore, although the effects are weaker, herbs may sometimes be used instead of pharmaceuticals for some individuals.

With my patients, we base our discussion around risk factors for heart disease, osteoporosis, breast cancer, uterine cancer, tolerance of hormonal medications, and so on. There are no black-and-white answers. Someone with a strong history of poor estrogen metabolism—such as uterine fibroids, ovarian cysts, endometriosis, or intolerance of birth control pills or other estrogens in the past may be better off without HRT. Someone at high risk for heart disease or osteoporosis may be better off using hormones. I suggest you discuss your options with a knowledgeable practitioner who is aware of the newer types of natural estrogens and progesterone medications now available.
—Jill Stansbury

Herbal Remedy Dosages

Recently, I’ve been told that an herbal remedy should not be taken over long periods because it reduces its effectiveness and that it should be taken for several weeks, then not taken for a week or two. Does this apply to all herbs? In particular, I’m wondering about wild yam, vitex, and black cohosh for easing PMS and menopausal problems.
T. B.
Littleton, CO

If one observes nature, our greatest teacher, one sees that everything is cyclic. In accordance with this cyclic pattern, herbs, even those that have no harmful side effects, are best taken in cycles. Tonic herbs are generally taken in a rotational cycle; these herbs are classified as “superior medicine” because they are safe, gentle, and meant to be used over a prolonged period of time. The cycle often suggested for tonics is generally five days on and two days off. This cycle can be repeated as long as necessary because there are no side effects or contraindications for long-term use.

Some herbs, especially those with specific medicinal actions or herbs rich in alkaloids, do have contraindications and may have side effects if used for prolonged periods of time. One should definitely follow a rotating cycle followed by a rest period to avoid any harmful side effects. Even an herb as familiar and commonly employed as goldenseal (Hydrastis canadensis) can have harsh side effects if used inappropriately.

Other herbs such as echinacea (Echinacea spp.) seem to lose their effectiveness if used for prolonged periods. Echinacea may still stimulate the immune system, but does so with less pizzazz. Studies show that it maximizes after roughly five days, so the suggested cycle with echinacea is five days on, two days off, repeating the cycle as needed. Though there are not many studies on other plants, my experience suggests that there are other herbs that lose their effectiveness if taken for prolonged periods with no rest cycle. With the use of the herbs you mentioned, a five-day-on, two-day-off cycle for four to six months would be appropriate.
—Rosemary Gladstar

Herbs generally do not lose their effectiveness over time. It’s more likely that they will become irritating or simply unnecessary when taken too frequently, for too long a duration, and at too high a dosage. Extensive herbal knowledge and refined prescribing are the keys to success.

When well indicated and carefully selected, many herbs should be taken daily for many months for best effects. Examples of this are Asian ginseng (Panax ginseng) to improve vitality, ginkgo (Ginkgo biloba) to improve memory, and milk thistle (Silybum marianum) to support liver function.

Herbs that have greater toxic or irritating potential are used more short term. For example, uva ursi (Arctostaphylos uva-ursi) is taken for ten days for a bladder infection, cascara sagrada (Rhamnus purshiana) is used one time only for sluggish bowel function, and goldenseal is used short term for sore throats.

The herbs you mention for regulating hormones are used in a fairly long-term way, reducing the dosage over time so that the effects may be maintained with a lower dose. The herbs may be tapered off or replaced with other treatments as the menopausal transition is completed and symptoms subside. When intending to use an herb for six months or many years, many herbalists and physicians will recommend taking a day or two off each week to provide a break from chronic usage.
—Jill Stansbury

Inflamed Elbow

I have recurring inflammation in my elbow, which has become infected a few times over the past fifteen years (some type of bursitis, I’ve been told). When it’s severe, my elbow is red, puffy, hot, and even a light touch is very painful. Aspirin helps, but if I take it for more than a day or two, I start bruising easily.

My doctor doesn’t know how to prevent this, nor was any treatment offered besides a strong antibiotic/anti-inflammatory combination. What can help this condition?
M. C.
Westville, Indiana

I have seen regular use of warm poultices relieve this type of inflammation and help heal the cause over a period of time. When the inflammation is active (red, puffy, and hot), make a warm poultice of fresh or dried comfrey (Symphytum officinale) leaves. Pour hot water over the leaves and blend in a blender to a thick mash. Wrap this mash in a large piece of cloth, and place directly against the inflamed area. Cover the cloth with a towel to help keep the warmth in as long as possible, and leave in place for 45 minutes or longer. Repeat this several times a week.

To make the poultice even more effective, try Kloss’s liniment on the inflamed area first. This liniment is a famous old recipe for inflammation and is found in Back to Eden (Benedict Lust Publications, 1981), the herbal classic by Jethro Kloss. You can make the liniment yourself by adding 1 ounce of myrrh (Commiphora spp.) powder, 1 ounce of goldenseal powder, and 1/4 ounce of cayenne (Capsicum annuum) powder to 1 pint of rubbing alcohol and letting it sit for two weeks. Strain it through a fine-meshed cheesecloth and rebottle the liquid. Gently spread it on the inflamed area.

When easy bruising occurs, include daily servings of antioxidant-rich foods such as carrots, spinach, and blueberries in your diet. It may be wise to supplement with a good antioxidant until the bruising is corrected; I suggest 2,000 mg of a vitamin C with bioflavonoids complex daily.

Many people suffering from arthritis, bursitis, and other muscular/skeletal type problems have reported relief by taking daily doses of glucosamine sulfate. I have found glucosamine to be very effective for reducing arthritic-like pain and enhancing cartilage regeneration. A suggested dose is 500 mg three times daily.
—Rosemary Gladstar

Bursitis can be caused by injury, gout, rheumatoid arthritis, or infections. Often, the cause is unknown. You should have a basic blood test done to make sure your uric acid (a metabolite of protein and purine digestion) is not elevated; if it is, you could be suffering from episodes of gout. Any fluid drained from the elbow during acute episodes may also contain accumulations of uric acid and should therefore be tested and evaluated by a pathologist. If this seems unlikely and the problem is infectious in origin as you suggest, echinacea may reduce the chronic tendency. Try using echinacea (two 150-mg capsules two times daily or two droppersful of the tincture two times daily) for two to three months. Decrease the dosage by one-half if symptoms improve after one month.

I would also search for any other clues. If you have other types of recurring infections such as simple colds or flus, I would definitely treat the immune system to resolve the elbow infections. If you have bowel problems or liver symptoms such as elevated liver enzymes, high cholesterol, difficulty digesting fat, or gas, nausea, or bloating after meals, I would treat the bowels, liver, and digestion to help rid the body of waste and improve the absorption of nutrients to treat the elbow. If you also experience other symptoms such as poorly healing wounds, swollen ankles, or tender enlarged lymph nodes, I would treat the lymphatic system to help treat the chronic infection.
—Jill Stansbury